Transfusion for hemostasis management in clinical guidelines “Acute promyelocytic leukemia”

Abstract

Summary. Introduction. Acute promyelocytic leukemia (APL) is a special rare form of acute myeloid leukemia (AML), which is dangerous mainly due to coagulopathy. The complex and not fully understood mechanism of coagulopathy in APL causes bleeding, thrombocytopenia, anemia, DIC, and hyperfibrinolysis, which require replacement transfusion therapy. Аim: to assess compliance of transfusion therapy recommendations in the clinical guidelines “Acute promyelocytic leukemia” (CG APL) with blood transfusion standards and the achievements of evidence-based medicine in the field of transfusion. Materials and Methods. We compared provisions concerning transfusion therapy in CG APL, approved by the Ministry of Health of the Russian Federation, with blood transfusion standards (laws, government decrees, orders of the Ministry of Health of the Russian Federation). Results. The following discrepancies were identified between the provisions of the CG APL and the current regulatory documents of the Blood Service: the patient information does not correspond to the subject of the recommendations; outdated blood components are used; an outdated laboratory indicator, the prothrombin index, is used; there are no provisions regulating the use of modern methods of hemostasis monitoring, in particular viscoelastic tests; there are no provisions regulating the immunohematological recipient examination and the selection of compatible blood components; there is a recommendation to use a fibrinogen concentrate that is not approved in Russia. Conclusion. The CG APL guidelines require revision and amendment to ensure their compliance with current regulatory requirements for transfusion therapy.

For citation: Zhiburt E.B., Khamitov R.G., Shestakov E.A., Madzaev S.R., Fedyk O.V., Shalygin L.D. Transfusion for hemostasis management in clinical guidelines “Acute promyelocytic leukemia”. Tromboz, gemostaz i reologiya. 2026;(1):69–75. (In Russ.).

References 

1.      Nikitin E.N., Vasiliev M.A. Modern views on the pathogenesis of coagulopathy in acute promyelocytic leukemia (a review). Zdorov’e, demografija, jekologija finno-ugorskih narodov. 2020;(4):55–60. (In Russ.).

1. Aung F.M., Myint J., Roughneen E.T., Lichtiger B. Transfusion needs in 28 cases of acute promyelocytic leukemia: a single institutional experience. Blood. 2013;122(21):4827. DOI: 10.1182/blood. V122.21.4827.4827.
2. Jillella A.P., Arellano M.L., Heffner L.T. et al. Managing acute promyelocytic leukemia in patients belonging to the Jehovah’s Witness congregation. Hematol Rep. 2017;9(3):7083. DOI: 10.4081/ hr.2017.7083.
3. Zhiburt E.B. New clinical guidelines for transfusiology: problems and solutions. Spravochnik zavedujushhego KDL. 2022;(1):21– 4. (In Russ.).

5.      Pokhabov D.S., Zhiburt E.B. Problems of blood transfusion in clinical guidelines «Ectopic pregnancy». Arhiv akusherstva i ginekologii imeni V.F. Snegirjova. 2023;10(2):155–60. (In Russ.). DOI: 10.1781 6/2313-8726-2023-10-2-155-160.

1. Pokhabov D.S., Zhiburt E.B. Blood transfusion in the standard of medical care for paroxysmal nocturnal hemoglobinuria. Problemy standartizacii v zdravoohranenii. 2023;(3–4):28–32. (In Russ.). DOI: 10.26347/1607-2502202303-04028-032.
2. PokhabovD.S., KuzminN.S., MadzaevS.R. et al. Blood transfusion in the standard of medical care for children with vitamin B12 deficiency anemia. Transfuziologija. 2023;24(1):45–52. (In Russ.).
3. Pokhabov D.S., Kuzmin N.S., Madzaev S.R. et al. Standard of medical care for adults with sickle cell disorders. Spravochnik zavedujushhego KDL. 2023;(1):42–53. (In Russ.).

9.      Kuznetsov S.I., Averyanov E.G., Shestakov E.A., Zhiburt E.B. Blood transfusion in the standard of medical care. Spravochnik zavedujushhego KDL. 2021;(3):41–51. (In Russ.).

10.  Pokhabov D.S., Khamitov R.G., Averyanov E.G. et al. Blood components in the standards of medical care. Transfuziologiya. 2024;25(3):155–64. (In Russ.).

11.  Pokhabov D.S., Kuzmin N.S., Madzaev S.R. et al. Pediatric transfusiology and modern blood components in Russian regulatory documents. Spravochnik zavedujushhego KDL. 2022;(11):47–58. (In Russ.).

12.  Maslova A.A., Yovdiy A.V., Smolnikova M.V. et al. Alloimmunization to erythrocyte antigens in a patient with acute promyelocytic leukemia against the background of bacterial infection (a case report). Transfuziologija. 2024;25(4):254–8. (In Russ.).

13.  Pokhabov D.S., Shestakov E.A., Madzaev S.R. et al. Validation of remote delivery of pathogen-reduced platelets. Tromboz, gemostaz i reologiya. 2025;(1):53–6. DOI: 10.25555/THR.2025.1.1130. (In Russ.).

14.  Gubanova M.N., Protopopova E.B., Zarubin M.V. et al. Polymorphism of preparation, transfusion and effectiveness of donor platelets concentrates. Tromboz, gemostaz i reologiya. 2016;(S3):136–7. (In Russ.).

15.  Protopopova E.B., Mochkin N.E., Melnichenko V.Ya. et al. Storage duration of platelets affect on transfusion effectiveness. Tromboz, gemostaz i reologiya. 2016;(S3):348–9. (In Russ.).

16.  Pokhabov D.S., Shestakov E.A., Fedyk O.V., Zhiburt E.B. Hemoglobin concentration and transfusion of ABO-unmatched platelets. Tromboz, gemostaz i reologiya. 2024;(1):30–6. (In Russ.). DOI: 10.25555/ THR.2024.1.1084.

17.  Tankaeva Kh.S., Shestakov E. A., Melnichenko V.Ya., Zhiburt E.B. Is group O platelet hemostatic activity reduced? Tromboz, gemostaz i reologiya. 2020;(3):75–8. (In Russ.). DOI: 10.25555/ THR.2020.3.0932.

18.  Shevchenko Yu.L., Karpov O.E., Zhiburt E.B. Blood transfusion: history and modernity (on the 100th anniversary of blood transfusion in Russia). Vestnik Nacional’nogo mediko-hirurgicheskogo centra imeni N.I. Pirogova. 2019;14(4):4–11. (In Russ.). DOI: 10.25881/ BPNMSC.2020.29.78.001.

19.  Zhiburt E.B., Gubanova M.N., Prokofieva I.V. Hemostasis issues in draft of guidelines for collection, storage, transportation and clinical use of donated blood and blood components. Tromboz, gemostaz i reologiya. 2016;(4):13–8. (In Russ.).

20.  Zhiburt E.B. Hemostasis issues in guidelines for collection, storage, transportation and clinical use of donated blood and blood components. Tromboz, gemostaz i reologiya. 2019;(4):9–12. (In Russ.). DOI: 10.25555/THR.2019.4.0894.

1. Zhiburt E.B., Khamitov R.G., Shalygin L.D. Inactivation of pathogens in pediatric transfusiology. Tromboz, gemostaz i reologiya. 2022;(2):33–40. (In Russ.). DOI: 10.25555/THR.2022.2.1017.
2. Cardigan R., New H.V., Estcourt L. et al. International Forum on policies and practice for transfusion of ABO and RhD non-identical platelets: responses. Vox Sang. 2022;117(1):e1-e20. DOI: 10.1111/ vox.13130.
3. KhamitovR.G., GavrileyA.V., DrozhzhinaI.E. et al. Difficulties in pooled platelets implementation. Tromboz, gemostaz i reologiya. 2022;(4):22–9. (In Russ.). DOI: 10.25555/THR.2022.4.1037.
4. Sabljic N., Thachil J., Pantic N., Mitrovic M. Hemorrhage in acute promyelocytic leukemia-fibrinolysis in focus. Res Pract Thromb Haemost. 2024;8(5):102499. DOI: 10.1016/j.rpth.2024.102499.
5. Sinkov S.V., Zabolotskikh I.B., Roitman E.V. Diagnosis and management of hemostasis system disorders. 2nd edition, revised and supplemented. Moscow: Obshchestvo s ogranichennoj otvetstvennost’yu «Prakticheskaya medicina», 2017. 336 рp. (In Russ.).
6.  Pokhabov D.S., Shestakov E.A., Fedyk O.V. et al. Thromboelastography and coagulogram in a multidisciplinary clinic. Tromboz, gemostaz i reologiya. 2023;(3):38–44. (In Russ.). DOI: 10.25555/ THR.2023.3.1067.
7. Kuznetsov S.I., Shestakov E.A., Zhiburt E.B. Coagulopathy in COVID-19 infection. Tromboz, gemostaz i reologiya. 2020;(4):31–4. (In Russ.). DOI: 10.25555/THR.2020.4.0942.
8. Roitman E.V., Gabay P.G. Clinical and legal aspects of the use of low molecular weight heparins in pediatrics. Pediatrija. Zhurnal imeni G.N. Speranskogo. 2021;100(3):135–41. (In Russ.). DOI: 10.241 10/0031-403X-2021-100-3-135-141.
9. Zhiburt E.B., Shestakov E.A. Evidence-based transfusiology. Part 1. On the rules for prescribing blood components. Zdravookhranenie.2007;(11):31–7. (In Russ.).
10. Zhiburt E.B., Shestakov E.A., Madzaev S.R., Shalygin L.D. Hemostasis and blood transfusion: randomized trials of 2023. Tromboz, gemostaz i reologiya. 2024(2):13–8. (In Russ.). DOI: 10.25555/ THR.2024.2.1094.
11. LindahlT.L., EgbergN., HillarpA. et al. INR calibration of Owren-type prothrombin time based on the relationship between PT% and INR utilizing normal plasma samples. Thromb Haemost. 2004;91(6):1223–31. DOI: 10.1160/TH03-07-0456.
12. Zhiburt E.B. Pediatrics transfusiology. Moscow: GEOTAR-Media, 2023. 344 pp. (In Russ.).